Individual provider Active NPI

Janice E Stern, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1720003577
Registry record updated Nov 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP0005491 Issued in WA
Practice address
1645 W Jackson Blvd Ste 602
Chicago, IL 60612
Phone
(312) 942-8387
Fax
(312) 942-8374
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP0005491 WA Primary

Addresses

Primary practice location

1645 W Jackson Blvd Ste 602
Chicago, IL 60612

Mailing address

1645 W Jackson Blvd Ste 602
Chicago, IL 60612-3276
Phone (312) 942-8387

Other practice location 1

2917 Pacific Ave
Suite 106
Everett, WA 98201-5307
Phone (425) 252-3133

Other identifiers 2

IdentifierTypeStateIssuer
0201797OtherWAL&I
9636879MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP0005491WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Psychiatric Clinic Inc Past Accepting new patients
Mindcare Solutions of Texas PA PastSince Aug 4, 2021 Accepting new patients
Okanogan Behavioral Healthcare PastSince Jul 1, 2002 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1720003577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD STE 602",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123276",
            "telephone_number": "312-942-8387",
            "fax_number": "312-942-8374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD STE 602",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-942-8387",
            "fax_number": "312-942-8374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2917 Pacific Ave",
            "address_2": "Suite 106",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982015307",
            "country_code": "US",
            "telephone_number": "425-252-3133",
            "fax_number": "425-252-3103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STERN",
        "first_name": "JANICE",
        "middle_name": "E",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP0005491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0201797",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9636879",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.